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Early intervention can help control mental illness

How many people know how to spot these signs and when to call for help?

Serious psychiatric illnesses can start out looking like a lot of other issues. (Dreamstime photo)

By Dr. Paul KurdyakUniversity of Toronto

Tues., Nov. 25, 2014

When psychiatrists read about tragedies like the Ottawa shooting, we scan the newspapers, bracing for the mental health warning signals that all too often come out after the fact and the invariable, problematic connection people make between mental illness and violence. In such stories, somebody usually noticed anti-social behaviour, paranoia, delusions — or maybe a recent history of substance abuse or criminal activity. Too often, for various reasons, the person didn’t get access to care.

These are obvious trouble signs to those of us who deal with seriously mental ill people every day. But I wonder how many people know how to spot these signs and when to call for help?

I work in a busy Toronto psychiatric emergency room, where people regularly bring in family members at crisis point. In many cases, the situation becomes very bad before someone gets the attention they need. That’s a tragedy in itself, since there’s solid evidence that the earlier we intervene, the better the outcome.

One problem is that serious psychiatric illnesses can start out looking like a lot of other issues. They may begin with absenteeism at work, increased drinking or drug use, or a slide in someone’s ability to function. In hindsight, many parents tell me their kids became more withdrawn, stayed in their rooms, skipped school and stopped hanging out with friends.

These may be symptoms of something else, like depression, family conflict or substance abuse. Either way, they should raise a red flag. In the early stages of possible mental illness, the best thing friends and family can do is keep the lines of communication open — and not to assume the loved one’s withdrawal means they don’t want to talk or there’s nothing to talk about. Be gentle, respectful, and ask open-ended questions that can’t be answered “yes” or “no.”

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With schizophrenia, psychosis or other serious mental health illness, a more obvious set of symptoms will emerge next. People in this situation might start talking about being monitored by police or feeling like they’re being followed. Or they may quietly mutter to themselves when alone, a sign they’re responding to hallucinations.

In bipolar disorder, a change in personality can be the biggest warning sign. You need to look out for the classic manic behaviour, when someone barely sleeps, but is full of energy and acts recklessly.

Then there’s very severe depression, which can bring on delusions, such as having cancer or going bankrupt. In the worst cases, people will slow down their thinking, talking and movements. Usually by the time things get that bad, people have missed many warning signs. I see people who fit this description in the emergency room and I’ve noticed they often come from cultures with stigma about mental health issues that pose a barrier to seeking help earlier.

These are all signs that your loved one needs immediate attention. Getting that help can be tricky because mental illness often robs people of the ability to see that they’re ill. Often, it’s difficult to persuade a loved one they need help. Being straightforward and honest about your concern is the best approach.

If you bring your loved one for assessment, your support is crucial. In the emergency room or a family doctor’s office, it can be tough to make a diagnosis and we need as much information as possible. When people are brought in by a relative who can describe in detail what’s going on, they’re much more likely to get the treatment they need.

But what if you don’t know someone very well and suspect they’re suffering from severe mental illness? A co-worker once told me about a neighbour who lived alone and screamed constantly. I suggested she call the police because officers can apprehend people under the Mental Health Act and take them to a psychiatric hospital.

My final word of advice is that reaching out to people is the most humane thing to do if you suspect they’re suffering from mental illness. They may be pulling away from others but they need human contact and compassion. And they need friends and family willing to watch carefully and act when necessary.

Dr. Paul Kurdyak is an Assistant Professor in U of T’s Department of Psychiatry, and Director of Health Systems Research at the Centre for Addiction and Mental Health. Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. If you have a question or comment for one of our experts, email doctorsnotes@thestar.ca .

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